Seven months after Rachel Lacy's death, medical and vaccine experts hired by the government ruled that her death was a "possible" or "probable" result of the vaccinations.

It's the only death that the Pentagon has officially acknowledged as being possibly related to the anthrax vaccine. The fact that Lacy got five vaccinations that day - including a smallpox shot - clouds the issue considerably. The vaccinations triggered her illness, but which vaccination did it? Or was it a combination of all?

CAUSE OF LACY'S DEATH STILL UNCLEAR

Officially, Lacy died of massive failures of lungs, heart and other organs. But the autopsy found widespread evidence of autoimmune problems as the likely cause of those failures.

The speed of her declining health was also remarkable. Shortly before the shots, Lacy got high scores on physical fitness tests. Two days after the inoculations, she could barely draw a breath.

Autoimmune problems involve the body's normal biological defense mechanisms going overboard and attacking healthy tissue, usually in reaction to a foreign substance entering the bloodstream. Doctors don't know why these reactions occur, and they're hard to diagnose in a living patient.

Often, they aren't determined until an autopsy. Even then, the diagnoses can be difficult.

"It's still a little unclear what she died from," says Jeffrey Sartin, an infectious-disease specialist who treated Lacy at a civilian hospital near Fort McCoy.

Lacy was eventually rushed to the Mayo Clinic, a world-renowned research hospital. She died within days. An autopsy there listed a number of underlying causes for the organ damage, including "lupus-like autoimmune disease."

Lupus is a type of autoimmune disease that affects mostly women. It attacks tissue in multiple organs, including the eyes, lungs and heart. Medical reports have been published about people with these problems after they received the anthrax vaccine. Those patients lived, so there were no autopsies done.

Lacy didn't have all the earmarks of lupus, though, Sartin says. The disease's cause isn't known, he says, but "there's some pretty good evidence that lupus can be triggered by vaccines and other things."

"Triggered" is the important word here, he says. Whatever went wrong in Lacy's body probably involved an underlying genetic condition unleashed when the drug or drugs entered her system. Some of those conditions are known to researchers, but there aren't good tests to identify those at risk.

Sartin says he suspects that Lacy's problems were more likely the result of the smallpox vaccination, or multiple vaccinations, than the anthrax shot alone. But he says that's probably because doctors have studied smallpox vaccine more extensively.

"We know a ton about the smallpox vaccine" because it's been given for more than 50 years, he says. "There really isn't very much on the anthrax vaccine."

Critics of the anthrax shot say that's because the military has a stranglehold on the money and data necessary to do that research.

"They track the flu vaccine for adverse reactions and not the anthrax vaccine, which is totally crazy to me," Steve Robinson says. He's executive director of the National Gulf War Resource Center, a veterans' advocacy group.

After the Mayo Clinic autopsy listed the anthrax and smallpox vaccines as part of the diagnoses for Lacy's death, the U.S. Department of Health and Human Services asked a group of medical experts to examine the case.

EXPERT PANEL SAYS VACCINE POSSIBLE CAUSE

John Sever, who led the panel of five experts, says the members split on their assessment of the matter after spending weeks examining the data. Three voted that her death was a "possible" result of the vaccinations she received, and two voted that it was "probable," his report says.

Both groups agreed that the connection in time was strong, based on how rapidly her health changed after receiving the vaccine. They also agreed that there was a plausible biological case to be made for the relationship. But they disagreed over whether there might be other possible unknown factors involved. That's the dividing line between "possible" and "probable" in these evaluations.

Complicating matters is that no one really knows what causes lupus or autoimmune diseases in the first place.

Pentagon officials say that while Lacy's death might be the result of the then-mandatory vaccination program, it was a rare and regrettable occurrence amid 1.4 million vaccinations.

Moses Lacy isn't impressed. "They told me one in 10,000 is acceptable. It is not. Not one in a million is acceptable because somebody loves that one person. Someone loves them."

Moses Lacy says he hopes that his daughter's story will make the military think twice about giving the shot. For those who decide to be inoculated, he hopes that her story will teach military doctors to be aware of complications that can follow.

On that point, he and the Pentagon agree: After Rachael Lacy's death, William Winkenwerder - assistant secretary of defense for health affairs - sent a memo to each of the surgeons general of the three branches that began: "The U.S. Army lost a valuable soldier in April 2003, a month after receiving five vaccinations. ..."

It went on to give a brief description of Lacy's illness and treatment, then gave instructions on how military doctors should be reminded to include the possibility of post-vaccination complications as part of their routine questions about any illness.

The letter specifically told military doctors to consider the possibility of autoimmune diseases and treatments.

SERIES INFO.

Moses Lacys daughter - Rachel, an Army combat medic - died of lupuslike complications that doctors think were triggered by one or more of the vaccinations she was given in preparation for going to Afghanistan.

A Civil War-period coat worn by a nurse — a woman from a prominent Mathews County family who some believe was the only woman to be commissioned as a captain in the Confederate Army — is among the nominees for Virginia's Top 10 Endangered Artifacts program.